Liver-directed therapy via intra-arterial chemotherapy has emerged as a useful adjunct in the treatment armamentarium for colorectal hepatic metastases not amenable to resection. Within the realm of transplantation oncology, liver transplant has also gained traction in recent years as a definitive treatment for unresectable metastatic colorectal disease to the liver in selected patients. Due to the technical complexity and highly specialized care required, the experience on liver transplant following intra-arterial therapy remains scant and limited to only few centers of excellence across the globe. In this chapter, we aim to summarize a two-center experience and expand on the indications, intraoperative considerations, complications, and outcomes in patients who received intra-arterial chemotherapy via hepatic artery infusion pumps and subsequently underwent liver transplantation.